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Our NET focuses on paediatric Magnetic Resonance Imaging (MRI) research. We focus on MRI research because it has been established as one of the safest methods for anatomical imaging. Its place in our hospitals is unlikely to be challenged, and therefore deserves careful analysis. We focus on children because as one commentator states, "neuroimaging pediatric patients is accompanied by all the ethical dilemmas associated with neuroimaging in adults, magnified exponentially" (Hinton 2002).
Since children are particularly vulnerable, MRI research in this population is more challenging. Unfortunately, this complexity may discourage paediatric MRI research which in turn may hinder the ability to interpret findings. Issues such as consent, risk, confidentiality, unanticipated findings, and the limitations of functional brain imaging, need to be closely examined in order to provide guidance for researchers proceeding in this field.
To date, there has not been adequate legal and ethical debate with respect to the issues surrounding MRI research involving children. A strong legal and ethical foundation needs to be constructed upon which sound policy decision, clinical guidelines and best practices, and research protocols can be built in the neuroimaging field.
| Project 1: "Laying the Foundation: Legal and Ethical Issues Regarding MRI Research Involving Children" |
In view of the scarcity of literature on the legal and ethical issues surrounding paediatric MRI research, this project is aimed at constructing a solid legal and ethical foundation on which sound policy decisions, clinical guidelines and best practices and research protocols can be built. The Project 1 Team will start by addressing the implications of unanticipated MRI findings, privacy and confidentiality concerns, ethical decision-making in resource allocation and attempts to balance the risks and benefits of paediatric MRI imaging.
| Project 2: "Minimizing Discomfort and Maximizing MRI Scanning Success for Children With and Without Cognitive Impairments" |
Project 2 will develop methods to deal with two significant problems encountered in paediatric MRI research: the anxiety and discomfort MRI scans cause children and the low quality imaging data resulting from the tendency for children to move during MRI procedures.
Through a series of three empirical studies, this project will develop and evaluate the effectiveness of age-relevant visual/written material for use in reducing anxiety, develop a systematic desensitization procedure to decrease fear and anxiety associated with MRI scanning, and use successive positive reinforcement methods to reduce children’s movement during MRI scans.
The foundational work completed in Project 1 will also inform and be informed by this project.
| Project 3: "Sedation Guidelines for Paediatric MRI Research" |
To address the anxiety and motion problems outlined above, children are sometimes sedated for MRI scans. However, the use of sedation carries risks. Project 3 will seek a thorough understanding of the nature and degree of these risks and will explore the range of current North American practices respecting the use of sedation for paediatric MRI research. It will also identify specific ways to reduce sedation risks.
Using this knowledge and the fruits of Project 1, the NET will address the following questions: (1) Does the present use of sedation for paediatric MRI scans meet current risk standards? (2) If not, can the risks be reduced such that they could meet the standards?
With the completion of the above groundwork, Project 3 will result in the development of recommendations for policy and practice with respect to the use of sedation in paediatric MRI research. Thus, the NET will move from theory to practice as it completes the process of legal/ethical issue identification, acquisition of scientific and medical knowledge, analysis of the issues utilizing this knowledge and, ultimately, the creation of specific recommendations.
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